Betty Davis Eyes… (Part II)


As discussed in the part I, TED (thyroid eye disease) can affect any one of us with autoimmune thyroid disease at any time before or after diagnosis and treatment. The thyroid antibodies that attack the thyroid can also attack the soft tissues of the eye. Unfortunately, the treatments available for autoimmune thyroid disease do not eliminate the antibodies just control the affect on the thyroid gland. So, it is important for us to recognize the signs and symptoms of TED and seek early treatment. TED can affect one or both eyes.

Common symptoms include:

  • sensivity to light
  • redness or swelling in the eye
  • watery eyes
  • sore eyes
  • dry eyes or a sensation of grit or sand in the eye
  • poor night vision
  • eye pain with movement
  • swelling of the upper eye lid(s)
  • blurred vision
  • protruding or bulging eyes
  • flashing lights

    Less common:

  • double vision
  • reduced sight in one or rarely both eyes
  • decreased color brightness
  • swelling of the lower lid(s)

    While only 5-10% will have severe TED, it is important to report these symptoms to your doctor. Keep in mind that not all Opthalmologists (MD or DO specializing in eye treatment) are familiar with TED. Ask your endocrinologist for a recommendation of one who specializes in TED. Early treatment can help to avoid complications like infection that can jeopardize your eyesight.

    The initial phase of TED is called the "hot phase" and may last 6-18 months. In this phase, the symptoms may worsen or be at their most severe. Generally, after the hot phase, the symptoms may spontaneously resolve or at least stabilize. Only about 20% may experience continued worsening symptoms and even those may eventually resolve.

    Treatment for TED depends on the severity of the symptoms. Eye drops or eye ointments may be used to control dryness. Eyes may be taped closed at night if necessary to prevent damage to the cornea. Using sunglasses will help prevent discomfort from light sensitivity. Elevating the head of the bed or sleeping on two or three pillows may help prevent or decrease swelling in the tissues around the eye.

    Surgery may be necessary to correct severe eyelid retraction. However, surgery should only be contemplated once the thyroid levels are back to normal. During the hot phase any surgery or trauma to the eye can make the problem worse.

    Taking corticosteroids by mouth can help to decrease the swelling in the soft tissue around the eye and decrease some of the discomfort and disfigurement of bulging eyes. In severe cases, external radiation or orbital decompression (removing some of the bone around the eye to allow more room) may be considered. Up to one-third of those with TED may require surgery, steroids or external radiation to resolve the problem.

    The copyright of the article Betty Davis Eyes… (Part II) in Thyroid Disease is owned by Keri. Permission to republish Betty Davis Eyes… (Part II) in print or online must be granted by the author in writing.

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